A new checklist for pandemic influenza planning emphasizes the role of occupational health to manage absenteeism, symptom surveillance, and personnel needs.

The Centers for Disease Control and Prevention in Atlanta issued a revised checklist for hospital preparedness to provide more specific guidance, says Deborah Levy, PhD, MPH, CDC's senior adviser for health care preparedness and a captain in the U.S. Public Health Service.

The checklist provides a roadmap for hospitals as they struggle to prepare for a pandemic amid a multitude of day-to-day challenges, says Levy. "Most facilities can't do everything at once, but they should work through [the checklist] and try to address all the issues in there," she says. "It does represent what they should be doing to get prepared for a pandemic."

Occupational health professionals are listed among those who should be included as members of a pandemic planning committee. The checklist also calls for hospitals to conduct tabletop simulation exercises and full-scale drills, and to update the plan regularly. (For an excerpt of the checklist, see box below.)

Can you manage employee absences during a pandemic?

This is an excerpt from the Hospital Pandemic Influenza Planning Checklist, prepared by the Centers for Disease Control and Prevention.

The facility's human resource and payment policies should be reviewed to identify and eliminate language that may encourage staff to work when ill or even when they are symptomatic with influenza-like illness and especially when they are within the period of communicability. An occupational health plan for addressing staff absences and other related occupational issues has been developed that includes the following:

A liberal/nonpunitive sick leave policy that addresses the needs of ill and symptomatic personnel and facility staffing needs during various levels of a pandemic health crisis considers the following:

The handling of personnel who develop symptoms while at work.

Allowing and encouraging ill people to stay home until no longer infectious.

When personnel may return to work after having pandemic influenza.

Personnel who need to care for family members who become ill or affected by closed care centers.

Personnel who must stay home to care for children if schools and child care centers close.

A plan to educate staff and volunteers to self-assess and report symptoms of pandemic influenza before reporting for duty; consider a phone triage system similar to that used for patients.

A list of mental/behavioral health, community, and faith-based resources that will be available to provide counseling to personnel during a pandemic.

A system to track annual influenza vaccination of personnel. (Having a system in place to track annual vaccination will facilitate documentation and tracking of pandemic influenza vaccine in personnel.)

A plan for managing personnel who at the time of a pandemic are at increased risk for influenza complications (e.g., pregnant women, immunocompromised workers, employees 65 years of age and older). A plan might include, for example, placing them on administrative leave, altering their work location, or other appropriate alternative.

The CDC is urging hospitals to coordinate their plans with public health, local emergency management agencies, and other health care facilities in the community. That coordination is one of the major gaps in pandemic planning, says Levy.

"For single events, shorter-term [emergencies], you can't survive doing [without joint planning]. You can't with a pandemic," she cautions.

In fact, hospitals may not be able to survive more than a week on their own during a pandemic, based on the results of a survey by Novation, a group purchasing organization based in Irving, TX. About half (54%) said they could last one to three days without "external resources," and another 25% said they could last up to seven days without "external resources," Novation reported. The results were based on responses from 68 hospitals.

"Our survey provides some real insight into the supply crisis hospitals would face during a global flu pandemic," Christine Miller, senior clinical manager at Novation, said in a statement.

Hospitals have made plans to obtain additional supplies, including respirators, in the event of a pandemic, the survey found. Two-thirds reported working collaboratively with other hospitals and distributors.

Ensuring adequate staffing and monitoring the health of employees will be a crucial component of pandemic response. The checklist encompasses a number of issues that would require employee health input or coordination, including:

Education: Employees need education on influenza and control measures as well as on the hospital's pandemic influenza plan. They need to know what policies will be in place and what operational changes may take place during a pandemic. The education portion of the plan will include credentialing and training of additional staff that may be brought in "to provide patient care when the hospital reaches a staffing crisis."

Symptom surveillance: Hospitals should test a method of symptom surveillance during the regular influenza season. "Hospital sites for syndromic surveillance should include the emergency department, hospital clinics, and occupational health. Surveillance reports are sent to hospital epidemiology/infection control personnel and to the local health authority," the checklist states. Hospitals also should have a system for monitoring seasonal influenza transmission among staff and patients as a precursor to the monitoring that would be necessary during a pandemic.

Antivirals and vaccine: As part of the plan, hospitals should consider how to allocate limited resources of vaccine or antivirals. They also should develop a list of key personnel "who are essential for maintaining hospital operations during an influenza pandemic who would be the first priority for influenza vaccination." Also, employee health will need a method for monitoring adverse reactions to the antiviral medications, the checklist says.

Personal protective equipment: Although the CDC has said that it would be "prudent" to use an N95 respirator for direct patient care activities during a pandemic, the checklist leaves open the possibility that hospitals will use surgical masks. It states that the hospital's infection control policy should require "at a minimum" Standard Precautions and Droplet Precautions with symptomatic patients. "If supplies of N95 or higher-rated respirators are not available, surgical masks can provide benefits against large droplet exposures," the checklist states. It also advises hospitals to estimate their PPE supply needs for an eight-week pandemic and "subsequent eight-week waves." Hospitals should have a list of alternative vendors and a plan for addressing supply shortages.

Other staff needs: Hospitals should have a plan to assist and support employees "whose family and/or personal responsibilities or other barriers prevent them from coming to work." That includes child care, elder care, transportation, and other issues. The plan also raises the possibility of quarantine: "A contingency plan has been developed in the event of hospital quarantine in conjunction with local jurisdictions to ensure quarantine is enforced and necessary supplies, equipment, and basic necessities can be delivered and maintained."